Over the past several years, Dr. Mangione-Smith has intensively studied issues related to quality of care and doctor-parent communication in pediatric encounters. This work has shown that excellent provider communication practices are one of the cornerstones of delivering high quality of care. At present, the candidate?s career goals are to continue to expand what is known about pediatric quality of care assessment and improvement and to translate this knowledge into practice. Much of her research has focused on a very specific area of care delivery - antibiotic prescribing for respiratory infections in children. Inappropriate antibiotic prescribing continues to be a serious public health problem in the United States. Understanding how doctor-parent communication affects clinical decision-making around antibiotic prescribing will facilitate the development of a quality improvement intervention to address this problem. Dr. Mangione-Smith has completed a comprehensive primary data collection for a project associated with a four-year award (granted in July 2000) from the Robert Wood Johnson Foundation. This study focuses on doctor-parent communication as a determinant of both inappropriate antibiotic prescribing and parent satisfaction with care. For the study, 38 pediatricians working in 27 different clinical sites were recruited between 10/15/00 and 6/15/01. Parents presenting with their children who were suffering from cold symptoms were recruited for study participation. With informed consent, both physicians and parents were surveyed and their encounters were videotaped. The analyses of these data will involve an in-depth assessment of the patterns of communication between the physicians and parents observed in the 570 pediatric acute care encounters. During the course of the Independent Scientist Award, the findings from this work will be used to develop a communication-based intervention to decrease antibiotic over-prescribing in the pediatric outpatient setting. The candidate will apply for additional funding to support the testing of the intervention that she develops in a randomized controlled trial. Understanding how doctor-parent communication affects clinical decision-making is critical to designing quality improvement interventions that are feasible, effective, and have long-term effects. The knowledge gained from this line of work should result in a valuable new mechanism for improving the quality of pediatric care.